Machine Learning in Medicine.

Are we about to be taken over by machines?

The first key step in realising any new technology in healthcare is communicating its value to both patients and healthcare staff. This can present a challenge when the discussion is around Machine Learning (ML) and Artificial Intelligence (AI) due to the associations, and often, misunderstandings, many people carry surrounding these terminologies. Nevertheless, informed patient consent in this area is vital and only fully informed when a decision has been made with the weighing up of accurate information. This is especially important in the issue of data ownership, where there can be confusion about what the implications of consent to 'use of data' means in healthcare today.

But if we can get beyond this issue of understanding and demystifying concerns about ML and AI then the vast benefits for modern medicine and the NHS are apparent; improved efficiencies in practice and resource management, enhanced precision and personalised medicine, more accurate diagnoses, treatments and prognoses.

Of course there are some concerns too that if ML algorithms are recognising patterns in large data sets and then spotting these same trends in new data then the alogortihm is only as good as the data it recieves. Currently the NHS IT infrastructure is fragmented and multi-layered which may pose challenges for acquiring reliable usable data. There may also be problems with algorithms overfitting to patterns in data and application may not suit the different context of primary and secondary care. Algorithms may also make mistakes, and keeping track of the reasoning and logic behind their outputs may be difficult and may limit how much their credibility and acceptance is seen in practice.

This technology will undoubtedly disrupt ways of working in modern medicine - but as human oversight is vital it can only be successful when applied in collaboration and partnership with clinicians and healthcare staff. For example, the role of a radiologist will likely change to more of a supervisor overseeing algorithms reporting hundreds of scans and clarifying discrepancies, but then, new roles and responsibilities will emerge in these new ways of working...more interventional working, or perhaps even more patient-facing care?

Underpinning all of this is of course the issue of accountability and where liability sits with the use of such technology. Will the clinician be responsible? Or the manufacturer? Or the healthcare provider? Whatever the end-point it seems now is a crucial time to bring together clinicians, industry and policy makers to support the development of governance regulation and standards to ensure the potential of this technology can be realised, but also trusted by society.

More Blog Posts on Meducation

A medical students reflection on Old Testament Ritual Law and it's health implications.
In an era before effective medical treatments, before science, and before evidence-based medicine, it is fascinating to see how the religious concept of ritual states (i.e. "clean" & "unclean"), helped the ancient Israelites to control disease in the population.
Summary of Leviticus 13: Laws on skin disease
If the skin disease was invasive (lit. "deeper than the skin") or potentially infectious (lit. involved open sores "raw flesh"), a person was declared "unclean". "Unclean" people lived in isolation from mainstream society (Lev 13:46).
If the disease was non-invasive the person was quarantined for 7 days then re-examined. If the disease had spread or faded, the person was declared unclean or clean respectively.
If there was no change they were quarantined for a further 7 days and then re-examined again. If after the second examination there had still been no spread or changes the disease was considered chronic and non-dangerous. Consequently, the person was declared "clean".
All "clean" people exiting quarantine had to wash their clothes (Lev 13:6,34).
If someone with invasive or open-sore disease healed, they returned to the priest to be re-examined & reclassified "clean". Conversely, if someone was declared "clean" and their disease developed to become invasive or open-sore disease they had to present themselves to be re-examined and reclassified "unclean".
Interpretations
I'm sure there are plenty of allegorical ways we can interpret Leviticus 13. Especially if we relate the skin diseases to the invasive and infectious nature of sin. But as a medical student I was fascinated looking at and considering the literal consequences of this passage, particularly in terms of the wider health implications it would have had on this ancient civilisation. Interesting...
(original post here)

This is an excerpt from "Fluids and Electrolytes Made Incredibly Easy! 1st UK Edition" by William N. Scott. For more information, or to purchase your copy, visit: http://tiny.cc/Fande. Save 15% (and get free P&P) on this, and a whole host of other LWW titles at lww.co.uk when you use the code MEDUCATION when you check out!
Introduction
The chemical reactions that sustain life depend on a delicate balance – or homeostasis – between acids and bases in the body. Even a slight imbalance can profoundly affect metabolism and essential body functions. Several conditions, such as infection or trauma, and certain medications can affect acid-base balance. However, to understand this balance, you need to understand some basic chemistry.
Understanding pH
Understanding acids and bases requires an understanding of pH, a calculation based on the concentration of hydrogen ions in a solution. It may also be defi ned as the amount of acid or base within a solution.
Acids consist of molecules that can give up, or donate, hydrogen ions to other molecules. Carbonic acid is an acid that occurs naturally in the body. Bases consist of molecules that can accept hydrogen ions; bicarbonate is one example of a base.
A solution that contains more base than acid has fewer hydrogen ions, so it has a higher pH. A solution with a pH above 7 is a base, or alkaline.
A solution that contains more acid than base has more hydrogen ions, so it has a lower pH. A solution with a pH below 7 is an acid, or acidotic.
Getting your PhD in pH
A patient’s acid-base balance can be assessed if the pH of their blood is known. Because arterial blood is usually used to measure pH, this discussion focuses on arterial samples.
Arterial blood is normally slightly alkaline, ranging from 7.35 to 7.45. A pH level within that range represents a balance between the concentration of hydrogen ions and bicarbonate ions. The pH of blood is generally maintained in a ratio of 20 parts bicarbonate to 1 part carbonic acid. A pH below 6.8 or above 7.8 is usually fatal.
Too low
Under certain conditions, the pH of arterial blood may deviate significantly from its normal narrow range. If the blood’s hydrogen ion concentration increases or bicarbonate level decreases, pH may decrease. In either case, a decrease in pH below 7.35 signals acidosis.
Too high
If the blood’s bicarbonate level increases or hydrogen ion concentration decreases, pH may rise. In either case, an increase in pH above 7.45 signals alkalosis.
Regulating acids and bases
A person’s well-being depends on their ability to maintain a normal pH. A deviation in pH can compromise essential body processes, including electrolyte balance, activity of critical enzymes, muscle contraction and basic cellular function. The body normally maintains pH within a narrow range by carefully balancing acidic and alkaline elements. When one aspect of that balancing act breaks down, the body can’t maintain a healthy pH as easily, and problems arise.

1. Sleep (I realize I’m posting this at 12:30 am…)
(http://www.helpguide.org/life/sleep_tips.htm)
I know there’s a popular perception of sleep deprivation going hand in hand with working hard or succeeding academically. However, that is only true if you’re working very last minute, and don’t care about retaining the information–you basically just want to get through your upcoming test/assignment. I would like to clarify that, although learning about 10 months of material in 2 weeks is overwhelming, it is NOT last minute because whatever you’re working on right now, you’ll have to remember in 2 weeks for your exam. Besides the exam, if you’re studying medicine, you need to remember most of these things for the rest of your life.
In order to retain that information, you need to stay alert, well rested and motivated. Prolonged sleep deprivation can make you feel very ‘CBA’ very fast.
2. Stay Energized
Sleep is only one factor in staying motivated and alert; another is staying energized¬–in a healthy way. Simply put: if you feel well, you’ll work well.
Eat well:
difficult, I know, when you’ve got so little time to spare; but as much as you can, try to eat more whole foods (aka things that don’t come in wrappers or have their own commercial) and keep a balanced diet (too much of anything is usually not good). Everyone snacks while they’re doing exams, but try to find a vice that won’t put you in a sugar coma (some good examples include berries and other fruits, nuts, carrots with hummus to dip in, granola bars, etc).
Note: drinking tea is also an excellent way to stay energized!
Stay active:
Again, I know something like this is difficult to keep up in normal everyday life, let alone during exam stress. Even if it is just for 15-20 minutes, some cardio (note: the more strenuous the workout in a short period of time, the more benefit you’ll get) is a fantastic ‘eye-opener’ (I learned that phrase while learning how to take an alcohol history and now I really like it)! No one wants to go for a run in the morning, but after you get past the first 2-3 minutes of wanting to collapse, your body starts to feel really grateful. This is the BEST way to stimulate your senses and wake yourself up. I promise it’s better than any energy drink or cup of coffee you could have.
Take small breaks: SMALL breaks!!! About 10 minutes. Every once in a while, you need to get up and walk around to give yourself a break, have some fresh air, grab a snack, but try not to get carried away; try to avoid having a short attention span.
3. Make Lists
I cannot stress enough how counterproductive it is to overwhelm yourself with the amount of work you have. Whether you think about it or not, that pile is not going anywhere. Thinking about it won’t wish it away. Stop psyching yourself out and just get on with it– step by step.
Making a list of objectives you need to accomplish that day or week is a great way to start; then, cross them out as you go along (such a satisfying feeling). Being able to visualize your progress will be a great motivator.
Remember: it is important to be systematic with your studying approach; if you jump around between modules because they’re boring you’re just going to confuse yourself and make it hard to remember things when that exam comes
Note: I have a white board in my room where I write my objectives for the week. Some days it motivates, some days it I want to throw it out the window (but I can't reach the latch)…
4. Practice Questions
Practice questions are excellent for monitoring your progress; they’re also excellent at scaring you. Do not fear! This is a good thing, because now you know what you’re missing, go back and read up on what you forgot to take a look at, and come back and do the questions later. Then give yourself a sticker for getting it right ? Practice questions are also great for last minute studying too because they can help you do what I call “backwards studying”–which is what I just described: figuring out what you need to learn based on what the questions look like.
5. Be realistic
Set realistic goals for yourself; most importantly, set realistic daily goals for yourself so that when you get all or most or even some of them done you can go to sleep with a level of satisfaction. Also, you need to pick your battles. Example: if you suck at neuro, then one module’s loss is another’s gain. Don’t spend too much time trying to get through one thing, just keep moving forward, and come back to it later
6. ‘Do not disturb’
Facebook, twitter, instagram, youtube, whatsapp, texting, pinterest, meme websites, so many fantastic ways to kill your time… Do yourself a favor, save them for your breaks. If someone is dying or on fire, they will most likely call you, not text you or write on your wall; you do not need to check your phone that often unless you're expecting something time sensitive.
7.Don’t Compare
Everyone studying in your program is going to be stressed about things; do NOT let it rub off on you. You know those moments when you hear a peer or a prof/tutor describing something you have never even heard of, then you start panicking? Yeah, don’t do that. It happens to everyone. Instead of worrying so much, just go read about it! Simple solution right? What else are you going to do? Plus, a lot of the time other students seem to know more than they need to about certain things (which I can tell you right now, doesn’t always mean they’re doing better than you; knowing random, very specific factoids doesn’t mean they can bring it in clinic. Everyone can pull a Hermione and know a book inside out, but this is not necessarily the hallmark of a good doctor), what’s it to you? Worry about yourself, be confident in your abilities, and don’t trouble yourself with comparing to other people
8.Practice for Practicals
Everyone is afraid of practical exams, like the OSCE (at any rest station you're likely to find me with my head in my hands trying to stabilize my breathing pattern and trying not to cry). The best way to be ready is to practice and practice and practice and practice. It’s like learning to drive a car. At first you’re too aware of your foot on the gas, the position of your hand on the wheel, etc; but, after driving for a little while, these things become subconscious. In the same way, when you walk into a station, you could be so worried about how you’ll do your introduction and gain consent, and remembering to wash your hands, and getting equipment and and and and and; the anxiety affects your confidence and your competence. If you practice enough, then no matter what they throw at you, you will get most of the points because the process will be second nature to you.
Practice on your roommates, friends, family members, patients with a doctor's help...when appropriate... Even your stuffed animals if you're really desperate.
DO NOT leave practicing for these practicals to the last minute; and if you do, make sure you go through every thing over and over again until you’re explaining examinations in your sleep.
NOTE: When I'm practicing for OSCE alone, I record myself over and over again and play it back to myself and criticize it, and then practice againn.
9.Consistency
You don’t necessarily have to study in the same place every day; however, it is always good to have some level of routine. Some examples include: waking up/sleeping at the same time everyday, going for a run at the same time every day, having the same study routine, etc. Repetition is a good way to keep your brain focused on new activities because, like I said before, the more you repeat things, the more they become second nature to you.
Hope these tips are of some use to you; if not, feel free to sound off in the comments some alternate ways to get through exams. Remember that while exams are stressful, this is the time where you build your character and find out what you’re truly capable of. When you drop your pen after that final exam, you want to feel satisfied and relieved, not regretful.
Happy Studying ?